When we first began working with various immunization registry programs over 10 years ago, we were really excited. What a great idea! All the data is there, why not use it to improve healthcare?  PCC interfaces with 15? 20? different states, for free, because we think it's such a good idea.

I even had a chance to speak at the CDC to a room full of uniformed health officers about the use of billing records to track immunizations. We'd been doing it for years with our clients with great success - printing school forms at the touch of a button still knocks the socks off most practices - but the CDC folks wouldn't buy it. "There's no way the billing data can be accurate. There are too many errors in the process!"

"Um," I replied, "how many billing mistakes, especially for imms, do you think a private practice can afford? If someone at the front desk isn't right 99.9% of the time, the practice loses a fortune. It may not be perfect, but it's more accurate than 1000s of people double-entering the data into some poorly designed UI from a state system."

That didn't go over well, to my surprise. Soon after that, we got in an argument with a particular state registry. I remember taking the call. "What do you mean you want to record the physician's social security number WITH EACH SHOT? That's crazy!"

It was then I realized that, too often, the goal of the registries isn't to improve immunization rates. It really isn't. If it were, we'd skip the docs and go straight to the insurance companies. They have all the data. In most states, getting the data from Medicaid (which the state controls anyway...) and BCBS would wrap up the imms records for 1/2 the kids, especially those most likely to need immunizations. But, no, that doesn't happen.

What I've been waiting for is the first official moment of punitive use of registries.  I expected that some state, based on comments we'd all heard from them during the interface process, would start punishing doctors whose data wasn't up-to-snuff.

To my surprise, one of the more effective and aggressive registries, has taken it a step farther.  Though I can't confirm this and I actually hope someone calls to tell me I'm wrong (and I'll gladly apologize and correct), it looks like that the state of Michigan will require you to use the registry if you want to get VFC vaccine.

Think about it for a second.  Doesn't this really mean that there will be physicians who won't or can't comply?  Which means that, ultimately, you've denied them VFC vaccine?  Which means that some kids will not be vaccinated?

Isn't this the opposite of how a registry should work?